SYNOPSIS: Overcoming Hearing Aid Fears: The Road to Better Hearing, by John M. Burkey, was written "to help people to keep hearing loss from affecting their quality of life." It informs the reader about ears, both normal and impaired, and about types of hearing loss and which types can be alleviated by hearing aids. The author relates an incredible number of concerns that people have raised about using hearing aids, reviews benefits of wearing hearing aids, and provides guidance for selecting hearing aids and "rejoining the hearing world." Several graphics, a glossary, and an annotated list of print and Web resources round out the book.

REVIEW: Even in Burkey's succinct, matter-of-fact descriptions of the ear, wonder about the hearing organ flourishes. I do not prescribe hearing aids. I just wear them. So I was fascinated by Burkey's description of the way in which the middle ear avoids losing much sound in the transition from air to fluids in the inner ear. And by the sensory nerves in the Organ of Corti. And by the inner ear's dual responsibilities—balance and hearing.

As a hospital chaplain, I was fascinated, amused, and sometimes shocked by the large number and the range of fears and objections that people bring to the subject of hearing aids. Audiologists may have a front-row seat on part of the human comedy. Burkey gives a good sense of what it must mean to be constantly engaged with people who are struggling with the human tendency to make as much mis-meaning as appropriate meaning out of their needs for help.

As a medical ethicist, I was interested to see the author's emphasis on quality of life. In the hospital, this phrase is often used in end of life situations. Burkey's use is more consistent with Jonsen, Siegler, and Winslade's use in their book, Clinical Ethics. The most fundamental goal of medicine is to improve the patient's quality of life. And I add, to maintain it at as high a level as possible, slow its decline, or raise its nadir.

Burkey dedicates more than a third of the book to actual examples of concerns, fears and doubts that he has heard from his clients. Adapting Kuebler-Ross's "stages" of dying to hearing loss, he provides clear examples of denial, anger, and bargaining/avoidance, but curiously, none of acceptance. Perhaps he intends to demonstrate acceptance in the case vignettes of other chapters. Charming claims of clients convey the unintended humor of some persons' denial of their hearing loss: beeps don't represent the client's actual hearing or other people have "super-hearing."

His review of issues that his clients have brought about hearing aids includes questions about appearance, about how hearing aids work and how their performance has improved, about the process of getting used to them, and some unusual concerns, such as, "Aren't hearing aids unnatural?"

Hearing aids benefit people, the author says, by helping them "expand their universe," improve their marriages and their relationships with their grandchildren, enhancing their work or even enabling them to work. That's just the very, very short list. They also confer benefits or reduce burdens on friends and family, who can often turn down the TV or stop shouting at their loved one.

As a consumer, I'm satisfied that the book covers the entire range of hearing aids and extras. He includes analog, programmable, and digital aids, hearing aids for those with complete loss of hearing in one ear, bone conduction hearing aids, disposable hearing aids, and personal amplifiers. He also reviews several add-on features that users may wish to consider. He provides sensible explanations as to why the cost of hearing aids continues to rise, while the cost of other electronic products is declining, and why health insurance does not cover hearing aides.

CRITIQUE: The book covers a wide range of matters well and succinctly. The concerns, fears, and doubts that people have about hearing aids; the application of Kuebler-Ross's stages; and the information about types of hearing aids were useful and satisfactory. I always cringe when I see people refer to Kuebler-Ross, because the stages are not well integrated with her case material. But Burkey makes appropriate departures from her model and provides good examples.

The main problem of the book is that the author is not clear who his audience is. That may just be an editing problem. Some professional jargon is incomprehensible to me as a layperson: "A small amount of the transition is overcome by the ossicles working in a lever action. More important is the size difference between the eardrum and the stapes bone." Huh? Some headings look like FAQs, but I can't imagine the language just popping right out of most consumers: "I didn't think hearing aids would help a sensorineural hearing loss." And I'd expect the author to address the reader directly as "you," if the book were for consumers. Throughout the book, excellent points are buried in paragraphs under headings that would not lead me to look for that material there. Finally, if the book is for audiologists, then I think it would need much more behavioral science information to guide audiologists in addressing clients' concerns, fears, and doubts. For either audience, the graphics of the ear need to be crisper.

I suspect that the author does not wear hearing aids. If he did, I think he would be more sensitive to the adventure that hearing becomes for people who have lost some hearing, but not their sense of humor. I am said to have mild hearing loss, and I still cannot hear soft-spoken people, punch lines, or the ends of sentences when certain people speak. Perhaps I'm not using the right program, but I stopped running through the options some time ago.

I'm not sure how to use the "Ear" ratings for this book. I would use "Gotta have" and "important and useful addition" for technical books or for books that I could easily give to clients and know that they would use comfortably. Certainly, it doesn't diminish this book's accomplishments to conclude that it is not a reference text. So I think it's somewhere between 3 and 4.